World Journal of Nuclear Medicine, Table of Contents

CC BY-NC-ND 4.0 · World J Nucl Med 2021; 20(03): 294-304
DOI: 10.4103/wjnm.wjnm_137_20

Original Article

Metabolic positron-emission tomography/magnetic resonance imaging in primary progressive aphasia and frontotemporal lobar degeneration subtypes: Reassessment of expected [¹⁸F]-fluorodeoxyglucose uptake patterns

Ana M. Franceschi

⁰Department of Radiology, Neuroradiology Section, Northwell Health/Donald and Barbara Zucker School of Medicine, Manhasset, Stony Brook, NY, USA

,

Kiyon Naser-Tavakolian

¹Departments of Radiology and Family and Population and Preventive Medicine, SUNY Stony Brook, Stony Brook, NY, USA

,

Michael Clifton

¹Departments of Radiology and Family and Population and Preventive Medicine, SUNY Stony Brook, Stony Brook, NY, USA

,

Lev Bangiyev

¹Departments of Radiology and Family and Population and Preventive Medicine, SUNY Stony Brook, Stony Brook, NY, USA

,

Giuseppe Cruciata

¹Departments of Radiology and Family and Population and Preventive Medicine, SUNY Stony Brook, Stony Brook, NY, USA

,

Sean Clouston

²Departments of Population and Preventive Medicine, SUNY Stony Brook, Stony Brook, NY, USA

,

Dinko Franceschi

¹Departments of Radiology and Family and Population and Preventive Medicine, SUNY Stony Brook, Stony Brook, NY, USA

› Author Affiliations

MedOne

Abstract

Clinical assessment of frontotemporal lobar degeneration (FTLD)/primary progressive aphasia (PPA) patients is challenging, given that common cognitive assessments rely extensively on language. Since asymmetry in neuroimaging biomarkers is often described as a central finding in these patients, our study evaluated [¹⁸F]-fluorodeoxyglucose (FDG) uptake patterns in patients meeting clinical and imaging criteria for FTLD, with emphasis on PPA. Fifty-one subjects underwent brain [¹⁸F]-FDG positron-emission tomography/magnetic resonance imaging (PET/MRI) as part of their routine clinical workup for dementia and neurodegenerative disease. Images were obtained using a Siemens Biograph mMR integrated 3T PET/MRI scanner. PET surface maps and fusion fluid-attenuated inversion recovery-PET images were generated utilizing MIMneuro software. Two board-certified neuroradiologists and one nuclear medicine physician blinded to patient history classified each FTLD/PPA subtype and assessed for left- versus right-side dominant hypometabolism. Qualitative and semiquantitative assessment demonstrated 18 cases of PPA, 16 behavioral variant frontotemporal dementia (bvFTD), 12 corticobasal degeneration, and 5 progressive supranuclear palsy. Among the 18 PPA subjects (11 svPPA, 5 lvPPA, and 2 agPPA), 12 (67%) demonstrated left-dominant hypometabolism and 6 (33%) right-dominant hypometabolism. While existing literature stresses left-dominant hypometabolism as a key imaging feature in the PPA subtypes, a third of our cases demonstrated right-dominant hypometabolism, suggesting that emphasis should be placed on the functionality of specific brain regions affected, rather than left versus right sidedness of hypometabolism patterns.

Keywords

Keywords

[¹⁸F]-fluorodeoxyglucose - frontotemporal lobar degeneration - hybrid neuroimaging - positron emission tomography/magnetic resonance imaging - primary progressive aphasia

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